Pathology/Lab Coding Alert

Revisions spotlight iron metabolism disorders.

If you ever bill transfusion medicine codes (86850-86999), you can't afford to miss ICD-9 revisions that will show medical necessity or report testing results for many of these services. You'll find transfusion reaction codes front and center in the recent CMS posting of ICD-9 2011 proposed codes. The changes are set to go into effect Oct. 1, 2010 -- watch for possible minor changes to the codes when the CMS releases the final version in the fall.

Why it matters: "Billing for a lab test using a 'truncated' ICD-9 code because you're not reporting the condition to the highest level of specificity means you might face denials for your services," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Expand Your Iron Overload Options

If you need to code hemochromatosis, ICD-9 2010 directs you to 275.0 (Disorders of iron metabolism). But you may have more specific options under ICD-9 2011. The plan is to make 275.0 invalid and replace it with the following:

275.01 -- Hereditary hemochromatosis

275.02 -- Hemochromatosis due to repeated red blood cell transfusions

275.09 -- Other disorders of iron metabolism

275.03 -- Other hemochromatosis.

Proposal: The FDA Center for Biologics Evaluation and Research (CBER) requested a code for transfusion-associated hemochromatosis (iron overload). "Hemochromatosis may result in organ damage, including heart, renal, and liver dysfunction," according to Mikhail Menis, PharmD, MS, of the FDA CBER, who presented the proposal at the ICD-9-CM  Coordination and Maintenance Committee Meeting (proposals, summaries, and presentation slides are available at www.cdc.gov/nchs/icd/icd9cm_maintenance.htm).

Transfusion-associated hemochromatosis may affect sickle cell anemia patients who have repeated transfusions, noted Jeffrey Linzer Sr., MD, FAAP, FACEP, who represented the American Association of Pediatrics at the meeting. The diagnosis may be appropriate when patients require chelation. You may see a number of inclusion terms added, such as Linzer's suggestion of "iron overload due to chronic transfusions," to help you match documented terms to ICD-9 definitions. David Berglund, MD, MPH, medical officer at the CDC's National Center for Health Statistics, presented a proposal for hemochromatosis codes, as well. He noted that a code for hereditary hemochromatosis could represent HFE-associated (type 1), juvenile (type 2), transferrin receptor 2 mutations (type 3), and ferroportin mutations (type 4).

The code for "other hemochromatosis" could include diagnoses such as aceruloplasminemia and dysmetabolic iron overload syndrome, Berglund suggested.

Bottom line: When the codes become official, pay careful attention to any "includes" notes to be sure you're pairing your case to the proper code. Time for a New TACO Code ICD-9 2011 also proposes to expand 2010's 276.6 (Fluid overload) to include the following:

276.61 -- Transfusion associated circulatory overload

276.69 -- Other fluid overload.

Menis presented this proposal, as well. He explained that transfusion-associated circulatory overload (TACO) "is a circulatory overload following transfusion of blood or blood components." The patient may experience "acute respiratory distress, increased blood pressure, pulmonary edema secondary to congestive heart failure, positive fluid balance, etc., during or within six hours of transfusion," he noted.

Pair PTP With 287.41

Another proposal would expand 287.4 (Secondary thrombocytopenia) to include:

287.41 -- Posttransfusion purpura

287.49 -- Other secondary thrombocytopenia.

The change would allow precise reporting of posttransfusion purpura (PTP), which usually arises five to 12 days after transfusion of blood components, Menis noted in his presentation.

Expect to Find FNHTR With Fevers

Patients may experience febrile nonhemolytic transfusion reaction (FNHTR) within four hours of transfusion, Menis noted. Signs include fever, chills, and rigors without hemolysis, he added.

Menis proposed the addition of 999.83 (Febrile nonhemolytic transfusion reaction [FNHTR]), which would have placed it under 999.8 (Other infusion and transfusion reaction).

The proposed rule, however, lists 780.66 (Febrile nonhemolytic transfusion reaction), placing FNHTR under 780.6 (Fever and other physiologic disturbances of temperature regulation). Check CMS Site for Full List With more than 130 proposed new codes, chances are you'll need to be familiar with many of the revisions and how they'll impact medical necessity for tests performed by your lab starting this fall. Be sure to scan the ICD-9 changes that CMS posted as part of the Inpatient Proposed Payment System, available online at www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp. To review the codes, download "Proposed Tables 6A-6K." Table 6A includes proposed new codes and 6C shows the proposed deletions.